In 2021 we explored recovery worker’s perceptions of the barriers to hepatitis C testing to better understand the challenges and potential solutions in reaching micro-elimination.
Barriers:
All recovery workers acknowledged staff lack of confidence, education and fear as barriers. Some identified peers as highly effective trainers.
“I did like it when the Hep C Trust peer was sharing…it was very well executed. Lived experience and delivery is important. He was really passionate…he made it feel important.”
Many stated testing was important but it was much lower down their list of priorities in comparison to managing risks.
“For me, I know it should be a priority, but it’s all scary, I don’t prioritise it. If I’m honest it’s one of the last things I think about.”
Some acknowledged frustration at repeatedly offering testing.
“Sometimes they get upset about you asking them again. Sometimes I get frustrated too, it’s like how many times do you want me to ask them?“
Some disclosed their anxiety around testing, feeling ‘out of the habit’, and some lacked the opportunities to test if a BBV lead did the majority of testing.
Infection control risks were mentioned by two workers, one concerned about their personal risk of infection, another concerned about the safe disposal of clinical waste.
“I get a bit worried about other peoples’ blood. I’m not from a clinical background. It might be about me being more proactive, there’s a cross over in roles. I wonder if it’s more me and my confidence, or that I accept that it will get done by someone else. I don’t get an opportunity sometimes because other people do it.”
Service user fear and anxiety due to lack of knowledge for needing the test, or feeling subjected to too many interventions in one appointment were factors.
“One service user needed advanced notice because they said they felt like a lab rat with us doing so many interventions.”
Covid-19 and the decrease in footfall were perceived as barriers. Recovery workers spoke of lack of outreach, advertising the testing, lack of money and restrictive policies. Lack of focus on testing and mixed messages from management about priorities played a role.
Solutions:
Recovery workers identified solutions which covered four themes – education, resources, culture and organisational processes, shifting focus. Staff wanted inspirational education, strategically placed leaflets, peer support, flexible resources (vans/vouchers/food/transport) and outreach. Flexibility, consistency, BBV leads, patient flow, routine testing, wrap-around services, community support and team cultures were mentioned throughout.
“Social aspects of teams can fuel changes in practice. Working with great teams. Good community networks.”
“I gave hep c info to needle exchange clients...we don’t reach them very well and we don’t use opportunities like that often enough. You’ve only got that moment to engage someone…they’re in a rush, we’re in a rush.”
It is clear from the barriers that complexities remain in reaching micro-elimination. However, despite the barriers, there were multiple parallel solutions.